confidentiality notice: this document contains confidential and privileged information and is for...

Confidentiality Notice: This document contains confidential and privileged information and is for the sole use of the intended recipients(s). Disclosure or distribution to and review or use by any unauthorized EyeMed or Luxottica associate(s) and all external parties is prohibited.

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EyeMed Vision CareNew State Vision Plan


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Agenda

EyeMed Vision Care Introduction Plan Overview Enrollment Obtaining Services EyeMed Web Overview Provider Network Key Contacts Key Points Questions/Comments


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Welcome To EyeMed Vision Care Employees will have the option to enroll in a voluntary,

100% employee-paid program effective 1/1/2010

Key highlights of the program include:

– Convenient Provider Options: Choose from hundreds of convenient locations throughout South Carolina and nationwide, including private practice providers, as well as leading optical retail chains

– Affordable Comprehensive Coverage: Program includes coverage for eye exams, eyeglasses and contact lenses with low copays and high allowances for very affordable monthly premiums

– Additional Savings: Savings of 40% off additional complete pairs of eyeglasses once benefits are exhausted, 20% off items not covered by the plan and 15% off conventional contact lenses


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The Importance of Vision Care 75% of Americans wear vision correction.

1 out of every 4 children ages five to twelve has a vision problem that will affect educational performance.

Vision benefits are just as important as medical and dental coverage. A comprehensive eye exam can help identify both vision related and major medical conditions such as diabetes, hypertension, multiple sclerosis and more.

1 in 5 people are at risk for vision loss and many of the problems could have been addressed through proactive care.

A slight vision miscorrection can reduce productivity by 10% and accuracy by 40%. 1 Jobson’s Optical Research Vision Watch Data 2006

2 Prevent Blindness America 20073 Employee Benefit News 20054 American Optometric Association5 Journal of the AOA, 2004


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Plan Overview Comprehensive program covers eye exams and eye wear

Current vision care discount program will still exist, but cannot be combined with the new program at the time of service. The new vision plan will also use a different network of providers.

Beginning January 1, 2010, BlueChoice HealthPlan and CIGNA HMO will no longer offer vision routine vision care coverage.

Anyone eligible for health insurance through the EIP is eligible for vision coverage.

Active employees may pay for vision before taxes are deducted through MoneyPlu$, and retirees can have premiums deducted from their pension checks.


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Eye Exam

• Standard contact lens fit – Applications of clear, soft, spherical (astigmatism less than .75D), daily wear contact lenses for single vision prescriptions. Does not include extended/overnight wear.

• Premium contact lens fit – More complex applications, including, but not limited to, toric (astigmatism .75D or higher), bifocal/multifocal, cosmetic color, post-surgical and gas permeable. Does include extended/overnight wear for any prescription.

Vision Care Services In-Network Member Cost Out-of-Network Plan Reimbursement

Comprehensive Exam with Dilation $10 Copay, Paid in full $35

Contact Lens Fit and Follow-Up:

Standard

Premium

$0 Copay, Paid-in-full fit and follow-up, up to 2 visits

$0 Copay, 10% off retail price, then apply a $55 allowance

$40

$40

Plan Overview


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Frames

• Frame benefit is applied toward the retail price of the frame


Any available frame at provider location

$0 Copay

$140 allowance

20% off balance over $140

$70

Plan Overview


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(Eyeglass) Lenses

Vision Care Services In-Network Member Cost

Out-of-Network Plan Reimbursement

Standard Plastic Lenses:Single VisionBifocalTrifocalLenticularStandard Progressive Lens

Premium Progressive Lens:-Image, Kodak Precise, Kodak Concise, Outlook SOLAMAX, Gradal Top, Gradal Brevity, Ovation, Natural, Compact Ultra, Short Fit, “MVP”

-Varilux Comfort, AO Easy, Hoyalux GP Wide, Gensis

-SOLAOne, Varilux Panamic, Varilux Ellipse, Definity, Hoyalux Summit

-Premium Progressive (Other)

$10 Copay$10 Copay$10 Copay$10 Copay$45 Copay

$71 Copay

$77 Copay

$83 Copay

80% of charge less $75

$25$40$55$55$55

$55

Plan Overview


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Lens Definitions

• Lenticular Lenses - An antiquated technology used in situations requiring such high plus power that a full field meniscus lens would be impractical (because of thickness, weight and fit). This area of power is usually located in the center of the lens and takes on the appearance of a "bubble.“ The amount of patients that need this type of lens has been decreased by improvements in cataract surgery.

• Progressive Lenses - Progressive lenses are often referred to as “no-line” bifocals or trifocals. They allow the wearer to have the benefits of multifocal lenses with a blended lens. These lenses have many advantages over bifocals and trifocals because they allow the wearer to focus at many different distances, not just two or three. Because they have no lines, progressive lenses allow a smooth transition between distances.

• Standard Progressive Lenses - Progressive lenses that could include basic lens option features such as Basic/Standard Anti Reflective properties and could be made out of plastic.

• Premium Progressive Lenses – Progressive lenses that could include premium properties such as Premium – Anti Reflective, UV coating, etc. and could be made with Polycarbonate or High Index lenses.

Plan Overview


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Lens Options

Vision Care Services In-Network Member Cost

Out-of-Network Plan Reimbursement

UV Coating

Tint (Solid and Gradient)

Standard Scratch Resistance

Standard Polycarbonate-Kids under 19

Standard Polycarbonate-Adults

Photocromatic Plastic Lenses (including Transitions)

Polarized

Other add-ons and Services

$0

$0

$0

$0

$30

$60

80% of charge

80% of charge

$5

$5

$5

$5

$5

$5

Anti-Reflective Coating:

Standard

Premium

-Crizal, Zeiss Carat, High Vision

-Crizal Alize, Teflon, Super High Vision, RF Endura EZ, Luxottica Anti-reflective coatings

Premium - Other

$45

$57

$68

80% of charge

$0

$0

Plan Overview


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Contact Lenses


Contact Lenses

(contact lens allowance

for materials only)

Conventional

Disposable

Medically Necessary

$0 Copay; $130 allowance, 15% off balance over $130

$0 Copay, $130 allowance

$0 Copay, Paid-in-Full

$104

$104

$200

Plan Overview

NOTE: The amount of contact lenses that can be bought with the $130 contact lens allowance depends on the type of contact lenses that are being purchased (i.e., daily, extended, multi focal, etc.).


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Contact Lens Definitions

• Standard contact lens fit – Applications of clear, soft, spherical (astigmatism less than .75D), daily wear contact lenses for single vision prescriptions. Does not include extended/overnight wear.

• Premium contact lens fit – More complex applications, including, but not limited to, toric (astigmatism .75D or higher), bifocal/multifocal, cosmetic color, post surgical and gas permeable. Does include extended/overnight wear for any prescription.

• Conventional Contact Lenses - Contact lenses designed for long-term use (up to one year); can be either daily or extended wear.

• Disposable Contact Lenses - Contact lenses designed to be discarded daily, weekly, bi-weekly, monthly or quarterly.

Plan Overview


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Medically Necessary Contact Lenses• Contact lenses are defined as medically necessary if the individual is

diagnosed with one of the following specific conditions:• Keratoconus where the patient is not correctable to 20/30 in either or

both eyes using standard spectacle lenses • High Ametropia exceeding -10 D or +10D in spherical equivalent in

either eye • Anisometropia of 3 D in spherical equivalent or more • Patients whose vision can be corrected two (2) lines of improvement on

the visual acuity chart when compared to best corrected standard spectacle lenses correction.

• All requests for medically necessary contact lenses must be submitted by provider for review and approval by our Medical Director before a claim will be processed for the service.

“Medically Necessary Form” will be available 1/1/2010:1) Visit www.eip.sc.gov, select your category and then select “Forms.”

Plan Overview


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Plan Overview

GroupMonthly

PremiumYearly

Premium1)Subscriber Only $7.76 $93.122)Subscriber + Spouse $15.52 $186.243)Subscriber + Child(ren) $16.48 $197.764)Subscriber + Family $24.24 $290.885)Surviving Children $8.72 $104.64

NOTE: *Based on “Subscriber Only” yearly premium

SINGLE VISION - ADULT

BenefitRetail

Charges In Network Benefit Member Out of

Pocket Member* Savings $

Member* Savings %

Exam 80.00$ $10 Copay, Paid in full 10.00$

Frames 140.00$ $140 allowance & 20%

discount off balance -$

Single Vision 75.00$ $10 Copay, Paid in full 10.00$

Polycarbonate (adults) 65.00$ $30 Copay, Paid in full 30.00$

Premium Anti Reflective (Crizal Alize) 92.00$ $68 Copay, Paid in full 68.00$

TOTAL 452.00$ 118.00$ 240.88$ 53.3%

Lenses


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Plan Overview

GroupMonthly

PremiumYearly



MULTI FOCAL - ADULT - GOOD

BenefitRetail



Member* Savings %

Exam 80.00$ $10 copay, Paid in full 10.00$



Standard Progressive 194.00$ $45 copay, Paid in full 45.00$

TOTAL 414.00$ 55.00$ 265.88$ 64.2%

Lenses


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Plan Overview

GroupMonthly

PremiumYearly



MUTI FOCAL - ADULT - BETTER

BenefitRetail



Member* Savings %




Premium Progressive (Varilux Comfort) 246.00$ $ 77 Copay, Paid in full 77.00$

TOTAL 466.00$ 87.00$ 285.88$ 61.3%

Lenses


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Plan Overview

GroupMonthly

PremiumYearly



MULTI FOCAL - ADULT - BEST

BenefitRetail



Member* Savings %




Premium Progressive (Vailux Physio 360) 310.00$ $ 77 Copay, Paid in full 77.00$

TOTAL 530.00$ 87.00$ 349.88$ 66.0%

Lenses


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Plan Overview

GroupMonthly

PremiumYearly



CONTACT LENSES

BenefitRetail



Member* Savings %


Standard Contact Lens Fit / Follow Up 74.00$ $0 Copay, Paid in Full -$

Disposable Contact Lenses 130.00$ $0 Copay, $130 allowance -$

TOTAL 284.00$ 10.00$ 180.88$ 63.7%

The amount of contact lenses that can be bought with the $130 contact lens allowance depends on the type of contact lenses that are being purchased (ie daily, extended, multi focal, etc).


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Benefit Frequency:

•Exam – Once every calendar year•Frames – Once every 2 calendar years•(Eyeglass) Lenses or Contact Lenses – Once every calendar year

EXAMPLES

Plan Overview

Service Date of Service Next Eligible DateExam 3-1-2010 1-1-2011Frames 3-1-2010 1-1-2012Lenses 3-1-2010 1-1-2011

Exam 3-1-2010 1-1-2011Frames 3-2-2010 1-1-2012Lenses 3-2-2010 1-1-2011

Example 1

Example 2


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Services do not have to occur on the same day:

EXAMPLES

Plan Overview

Example 3

Example 4

Service Date of Service Next Eligible DateExam 3-1-2010 1-1-2011Frames 3-2-2010 1-1-2012Lenses 3-3-2010 1-1-2011

Exam 3-1-2010 1-1-2011CL Fit/Follow Up 1 3-1-2010 1-1-2011CL Fit/Follow Up 2 3-2-2010 1-1-2011Contact Lenses 3-3-2010 1-1-2011


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Services can be rendered by different Providers:

EXAMPLES

1) All services at the same Provider1) All services at the same ProviderExam / Frame / Lenses – Provider A

2) Services across different Providers2) Services across different ProvidersExam - Out of Network Provider AFrames & Lenses - In Network Provider B

NOTE: It does not matter if the provider is In-Network or Out-of -Network - Independent or Retail --- any combination is valid!

*Benefits are applied based on where services are occurring.

Plan Overview


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Sample combinations of benefit usage:

A) Comprehensive Exam and/or Contact Lens Fit & Follow Up:

B) Frame & Eyeglass LensesC) Contact LensesD) Frame & Contact Lenses (member receives 20% off eyeglasslenses since funded benefit for eyeglass lenses cannot be

used).

NOTE: If you have an existing pair of Frames, you can use your benefit to buy new Lenses as long as they can be fitted.

Plan Overview


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Key Points:

1. Special promotions/discounts cannot be combined with the State’s vision plan.

2. Other vision plans (AAA, AARP, etc.) cannot be combined with the State’s vision plan.

3. Contact Lens allowance works on a declining balance.NOTE: Declining balance cannot be used across an In Network & Out OfNetwork provider.

4. Frame Allowance is not on a declining balance; use it all at once (or lost).

Plan Overview


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Key Points:

5. Out of pocket vision expenses qualify towards an FSA account.

6. The benefit covers prescription Sunglasses.

Plan Overview


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Plan Overview

Additional Discounts:

1. Once the benefit is used, there is an additional 40% discount off complete pair of eyeglasses (frame & lens must be purchased at the same time).

2. Once the benefit is used, there is an additional 15% discount off conventional contact lenses.

3. Member will receive a 20% discount on remaining balance at In Network Providers beyond plan coverage.

4. LASIK – Through U.S. Laser network, obtain a 15% off retail price OR 5% off Provider’s promotional pricing – all requests must go to 877-5LASER6 (877-552-7376).


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Post Enrollment

Once enrolled, all enrollees will receive a packet that includes:1. 2 ID Cards2. Nearest providers3. Plan Design


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Out Of Network Provider

EyeMed Out Of Network Claim form will be available 1/1/2010:www.eip.sc.gov, choose your category & select “Forms”

Obtaining Services

In Network Provider

Provider files claim for member.

www.eyemedvisioncare.com


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Provider Network

Hundreds of convenient locations throughout South Carolina and thousands nationwide, including:


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EyeMed Customer Care – for anyone

Toll Free Telephone: 877-735-9314

NOTE: Menu options change from Open Enrollment time to January 1, 2010.

Key Contacts – EyeMed CC

• Available 362 days a year (Closed Thanksgiving, Christmas and Easter)

• Language line translation services for more than 150 languages

Monday – Saturday; 8 am – 11 pm ESTSunday; 11 am – 8 pm EST

confidentiality notice: this document contains confidential and privileged information and is for...

Documents

sole use

unauthorized eyemed

vision benefits

eyemed vision care employees

vision loss

vision problem

vision correction

importance of vision